Indiana State Department of Health


Division of Long Term Care

 

CONSUMER REPORT

 

SIMMONS LOVING CARE HEALTH FACILITY

 

NURSING HOME


SKILLED NURSING FACILITY / NURSING FACILITY DISTINCT PART

Created on: 2/23/2024

 
Posted to the Web on: 3/6/2024
 
 






Basic Information


FACILITY CONTACT INFORMATION:
Address: 700 E 21ST AVE
City: GARY
Telephone: (219) 882-2563
Web Site:  
 
NAME CHANGES:
Most recent name change: N/A
Date of most recent name change: N/A
 
LICENSE INFORMATION:
  License number: 23-000368-1
  License effective date: 5/1/2023
  License expiration date: 4/30/2024
 




Administration and Staff


Administrator: HERBERTA B MILLER
  Start date: 5/26/2023
 
Director of Nursing: RAENITA D MILLER DUMAS
  Start date: 8/4/2023
 
Medical director:  
  Start date:   /  /  
 
Wound care specialist:  
  Start date:   /  /  
 
Infection preventionist:  
  Start date:   /  /  
 




Ownership


CURENT OWNERSHIP:
 
Owning corporation: PULASKI MEMORIAL HOSPITAL
616 E 13TH STREET
WINAMAC IN 46996
 
Ownership type:  NON-PROFIT
 
Officer(s): MICHAEL MCKAY
            VALERIE LEMAN
            LINDA WEBB
            CHARLES HUTTON
            GREGG MALOTT
            CLINT KAUFFMAN
            STEVE JAROSINSKI
            ADAM BENNETT
            JENNIFER SMITH
            CAITLIN BARRY
            TAYLOR WHITE
 
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: SIMMONS-MILLER INVESTMENTS INC
Date of last change of ownership: 5/1/2018
 




Bed Counts and Census


COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF):                     16
Number of Medicare beds (SNF):                    0
Number of Medicare/Medicaid beds (SNF/NF):        30
Number of non-certified comprehensive care beds (State Licensed only):     0
Total number of comprehensive care beds:     46
 
RESIDENTIAL CARE BEDS:
 
Total number of residential beds:            0
 
Total number of beds in facility:            46
 
CENSUS:
Facility census:  20
As reported by the facility on: 8/10/2023 
 
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 8/10/2023 
 
Residential care beds occupied:  0
As reported by the facility on: 8/10/2023 
 
Alzheimer Beds:  0
Alzheimer Beds Occupied:  0
As reported by the facility on:   /  /  
 
Ventilator Beds:  0
Ventilator Beds Occupied:  0
As reported by the facility on:   /  /  
 




Sprinklers and Smoke Detectors


This facility is: FULLY SPRINKLERED
 
Number of comprehensive care resident rooms: 20
Number of comprehensive care resident rooms with battery 
                    operated smoke detectors: 20
Number of comprehensive care resident rooms 
             with hard wired and/or wireless smoke detectors: 0
 
Person completing form - RAENITA DUMAS
Title of the person who completed the sprinkler, smoke detector form submitted to the ISDH. DON
Date form completed - 4/10/2023
 




Nurse Aide Training


NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved:  
Nurse aide training and competency evaluation program (NATCEP) expires:  
Nurse aide training and competency evaluation program (NATCEP) banned: Yes
Nurse aide training and competency evaluation program (NATCEP) ban expires: 4/4/2025
 
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites: 
     GERIC HOME HEALTH CARE INC
         Approved: 7/31/1998
         Terminated: 6/10/2004
     NORTHWEST INDIANA INSTITUTE
         Approved: 1/14/2000
         Terminated: 6/10/2004
     GERIC HOME HEALTH CARE INC
         Approved: 1/31/1997
         Terminated: 6/10/2004
     V R ASHWOOD TRAINING INSTITUTE LLC
         Approved: 4/30/2015
         Terminated: 7/20/2019
     AMBASSADOR NURSES AIDE TRAINING
         Approved: 4/14/2015
         Terminated: 7/20/2019
     GARY AREA CAREER CENTER
         Approved: N/A
         Terminated: 10/25/2006
     IVY TECH STATE COLLEGE NORTHWEST
         Approved: 3/21/1997
         Terminated: 6/10/2004
     DESTINY SCHOOL OF NURSING
         Approved: 12/18/2015
         Terminated: 7/20/2019
 




Complaints



NUMBER OF SUBSTANTIATED COMPLAINTS: 
 
  Current year:  0
  Previous year:  1
  2 years previous:  4


 




Facility Report Card






 




 
3/1/2020 Current QTR
12/1/2019 Previous QTR
9/1/2019 Previous QTR
6/1/2019 Previous QTR




Report Card Score
0
0
0
0




Rank of Score
100
100
100
100




Average Score
302
296
295
296





 
*Facility report card scores have not been updated since March 1, 2020 due to changes in the survey process during the ongoing COVID-19 pandemic. 
The facility report card score is calculated four times per calendar year 
for the two most recent nursing home health surveys.  The facility report card score 
also includes all complaint surveys, life safety code surveys, emergency preparedness surveys, 
and any follow-up surveys that occur within the two most recent nursing home health surveys. 
The facility report card score ranges from 500 to 0, with 500 being the best score possible. 
 
View the Scope and Severity grid
 
View the scoring methodology
 






Overview of Survey findings








 
 The Most Recent Set
 2ND Most Recent Set
 3RD Most Recent Set


Immediate Jeopardy
No
Yes
No




 Substandard Quality of Care 
Yes
Yes
No




Administrator Change
No
No
No




Owner Change
No
No
No




Number of Substantiated Complaints With Deficiencies
0
0
0




Deficiency Free Standard Health Survey
No
No
No





 
    The term 'Recent Set' referenced above relates to the referenced annual survey,
    and any other surveys performed between it and the previous annual survey.
 


 




Enforcement Actions


Event ID: 127T12
  Notice to facility: 8/7/2023
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: N/A
  Initial Amount: $Null
Event ID: 127T12
  Notice to facility: 8/7/2023
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: N/A
  Initial Amount: $Null
Event ID: CWMF12
  Action - Probationary license
  Notice to facility: 3/1/2023
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: N/A
  Initial Amount: $0
Event ID: VVP111
  Action - Citation / Fine
  Notice to facility: 7/14/2021
             Appeal: N/A
  Action Cease/Recind: N/A
         Case Closed: N/A
  Initial Amount: $1500
 
Federal Certification Actions Imposed
     Civil Money Penalty
     Date Imposed: 2/20/2024  Date Ended: 2/20/2024
     Amount proposed per day: 7527
     Civil Money Penalty
     Date Imposed: 2/12/2024  Date Ended: 2/12/2024
     Amount proposed per day: 7527
     Civil Money Penalty
     Date Imposed: 1/22/2024  Date Ended: 2/6/2024
     Amount proposed per day: 7527
     Amount proposed per day: 7527
     Amount proposed per day: 7527
     Civil Money Penalty
     Date Imposed: 1/8/2024  Date Ended: 1/8/2024
     Amount proposed per day: 7527
     Civil Money Penalty
     Date Imposed: 1/2/2024  Date Ended: 1/2/2024
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 12/11/2023  Date Ended: 12/26/2023
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 11/20/2023  Date Ended: 11/20/2023
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 11/13/2023  Date Ended: 11/13/2023
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 11/6/2023  Date Ended: 11/6/2023
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 10/30/2023  Date Ended: 10/30/2023
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 10/23/2023  Date Ended: 10/23/2023
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 10/17/2023  Date Ended: 10/17/2023
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 9/25/2023  Date Ended: 10/10/2023
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Discretionary Termination
     Date Imposed: 8/25/2023  Date Ended: Still in effect
     Directed Plan of Correction
     Date Imposed: 5/6/2023  Date Ended: Still in effect
     Discretionary Deny Pay for New Admits
     Date Imposed: 5/6/2023  Date Ended: Still in effect
     Civil Money Penalty
     Date Imposed: 4/17/2023  Date Ended: 5/2/2023
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Civil Money Penalty
     Date Imposed: 3/6/2023  Date Ended: 3/20/2023
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Amount proposed per day: 6993
     Directed Plan of Correction
     Date Imposed: 12/23/2022  Date Ended: 2/24/2023
     Directed Plan of Correction
     Date Imposed: 11/4/2022  Date Ended: 2/24/2023
     Discretionary Deny Pay for New Admits
     Date Imposed: 9/16/2022  Date Ended: 2/23/2023
     Civil Money Penalty
     Date Imposed: 8/25/2022  Date Ended: 11/28/2022
     Amount proposed per day: 
     Amount proposed per day: 
     Amount proposed per day: 
     Directed Plan of Correction
     Date Imposed: 5/13/2022  Date Ended: 5/16/2022
     Civil Money Penalty
     Date Imposed: 4/21/2022  Date Ended: 4/21/2022
     Amount proposed per day: 
     Civil Money Penalty
     Date Imposed: 3/14/2022  Date Ended: 3/14/2022
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 1/10/2022  Date Ended: 1/10/2022
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 1/3/2022  Date Ended: 1/3/2022
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 12/27/2021  Date Ended: 12/27/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 12/20/2021  Date Ended: 12/20/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 12/13/2021  Date Ended: 12/13/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 12/6/2021  Date Ended: 12/6/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 11/29/2021  Date Ended: 11/29/2021
     Amount proposed per day: 6500
     Discretionary Deny Pay for New Admits
     Date Imposed: 11/25/2021  Date Ended: 12/20/2021
     Directed Plan of Correction
     Date Imposed: 11/25/2021  Date Ended: 12/21/2021
     Civil Money Penalty
     Date Imposed: 11/22/2021  Date Ended: 11/22/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 11/15/2021  Date Ended: 11/15/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 10/25/2021  Date Ended: 12/20/2021
     Amount proposed per day: 
     Amount proposed per day: 2810
     Civil Money Penalty
     Date Imposed: 9/27/2021  Date Ended: 9/27/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 9/20/2021  Date Ended: 9/20/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 9/13/2021  Date Ended: 9/13/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 9/6/2021  Date Ended: 9/6/2021
     Amount proposed per day: 6500
     Directed Inservice Training
     Date Imposed: 8/31/2021  Date Ended: 12/21/2021
     Civil Money Penalty
     Date Imposed: 8/30/2021  Date Ended: 8/30/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 8/23/2021  Date Ended: 8/23/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 8/16/2021  Date Ended: 8/16/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 8/9/2021  Date Ended: 8/9/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 8/2/2021  Date Ended: 8/2/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 7/12/2021  Date Ended: 7/12/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 7/5/2021  Date Ended: 7/5/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 6/28/2021  Date Ended: 6/28/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 6/21/2021  Date Ended: 6/21/2021
     Amount proposed per day: 6500
     Discretionary Deny Pay for New Admits
     Date Imposed: 5/28/2021  Date Ended: 7/7/2021
     Directed Plan of Correction
     Date Imposed: 5/28/2021  Date Ended: 7/8/2021
     Civil Money Penalty
     Date Imposed: 5/24/2021  Date Ended: 5/24/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 5/17/2021  Date Ended: 5/17/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 5/10/2021  Date Ended: 5/10/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 5/3/2021  Date Ended: 5/3/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 4/27/2021  Date Ended: 7/7/2021
     Amount proposed per day: 
     Amount proposed per day: 1945
     Civil Money Penalty
     Date Imposed: 4/26/2021  Date Ended: 4/26/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 4/19/2021  Date Ended: 4/19/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 4/12/2021  Date Ended: 4/12/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 4/5/2021  Date Ended: 4/5/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 3/29/2021  Date Ended: 3/29/2021
     Amount proposed per day: 6500
     Civil Money Penalty
     Date Imposed: 3/22/2021  Date Ended: 3/22/2021
     Amount proposed per day: 6000
     Civil Money Penalty
     Date Imposed: 3/15/2021  Date Ended: 3/15/2021
     Amount proposed per day: 5500
     Civil Money Penalty
     Date Imposed: 3/8/2021  Date Ended: 3/8/2021
     Amount proposed per day: 5000
     Civil Money Penalty
     Date Imposed: 3/1/2021  Date Ended: 3/1/2021
     Amount proposed per day: 4500
 
Date terminated from Medicare/Medicaid: N/A
 




Survey History




    The survey report is not posted until the report has been provided to the facility and their plan of correction submitted and approved.
    The survey report therefore will likely not be posted until four to six weeks after the exit date.
        
    In the grid below click on an event ID that is underlined to see the survey report for that event.




 
Event ID
Survey Type
Exit Date


EV7E11
Other
9/5/2023




V3YN12
Complaint, Follow Up
7/17/2023




127T12
Recertification, Complaint, Follow Up, State Licensure
7/17/2023




EBJK12
Complaint, Follow Up
7/17/2023




DWUM11
Complaint
7/17/2023




127T22
Follow Up, Life Safety Code, Recertification
6/30/2023




V3YN11
Complaint
6/13/2023




127T21
Recertification, Life Safety Code
5/4/2023




127T11
Recertification, Complaint, State Licensure
4/5/2023




EBJK11
Complaint
3/23/2023




Y2ZE12
Complaint, Follow Up
2/24/2023




CWMF14
Recertification, Follow Up, State Licensure
2/24/2023




Y2ZE11
Complaint
2/7/2023




CWMF13
Recertification, Follow Up, State Licensure
2/7/2023




MEJ413
Complaint, Follow Up
11/28/2022




CWMF12
Recertification, Follow Up, State Licensure
11/28/2022




O15811
Complaint
11/28/2022




CWMF21
Recertification, Life Safety Code
10/31/2022




CWMF11
Recertification, State Licensure
10/6/2022




MEJ412
Complaint, Follow Up
10/6/2022




MEJ411
Complaint
8/25/2022




XSLF22
Recertification, Follow Up, Life Safety Code
6/30/2022




XSLF12
Recertification, Complaint, Follow Up, State Licensure
6/8/2022




XSLF21
Recertification, Life Safety Code
5/16/2022




XSLF11
Recertification, Complaint, State Licensure
4/21/2022




VSWO12
Complaint, Follow Up
4/1/2022




VSWO11
Complaint, Other
3/3/2022




RH7V22
Recertification, Follow Up, Life Safety Code
12/22/2021




DIE411
Complaint
12/21/2021




1WJY12
Complaint, Follow Up
12/21/2021




RH7V12
Recertification, Complaint, Follow Up, State Licensure
12/21/2021




RH7V21
Recertification, Life Safety Code
12/6/2021




RH7V11
Recertification, Complaint, State Licensure
10/29/2021




1WJY11
Complaint
8/9/2021




VVP112
Recertification, Complaint, Follow Up, State Licensure
7/8/2021




VVP122
Recertification, Follow Up, Life Safety Code
6/29/2021




VVP121
Recertification, Life Safety Code
5/3/2021




VVP111
Recertification, Complaint, State Licensure
4/27/2021





 
 




Links and Resources


 
CMS nursing home compare page 
 
    In addition to the information provided on this 
    web site, the Centers for Medicare & Medicaid Services (CMS) has a web site 
    which contains information on every Medicare and Medicaid certified nursing 
    home in the country. The CMS nursing home survey results contain summary information 
    about a facility's noncompliance of regulations regarding the care of residents 
    found in the nursing homes. You can locate nursing homes in your area and find 
    information about compliance with federal regulations.
 
Resources and links to other organizations
 
Choosing a Nursing Home
 
Overview of the Survey Process
 
State Wide Grouping of all Scores
   
Overview of current comprehensive facility scores
   
Spreadsheet of current comprehensive facility names and scores
   
Legal Disclaimer for Long Term Care Reports.